Run Cross-Connection Control Survey — Free

Inspection Details

Property address and account information recorded

Inspection date and time recorded

Inspector name and organization recorded

Survey scope confirmed with property representative critical (required)

Yes No N/A

Access to all relevant areas granted for walk-through critical (required)

Yes No N/A

Water Service Entry and Meter Area

Main service entry and meter location identified critical (required)

Yes No N/A

Visible piping, valves, and fittings at service entry are labeled or traceable

Yes No N/A

Evidence of unauthorized bypass, tee, or unapproved connection at service entry critical (required)

Yes No N/A

Meter pit, vault, or enclosure is accessible and free of flooding or contamination critical (required)

Yes No N/A

Service entry area supports safe inspection and maintenance access

Yes No N/A

Cross-Connection Identification

Irrigation, fire suppression, process, or auxiliary water connections identified critical (required)

Note (optional)

Potential cross-connection points observed during walk-through critical (required)

Cross-connection hazards isolated from potable supply where observed critical (required)

Yes No N/A

Auxiliary water sources identified and protected from backflow critical (required)

Yes No N/A

Any temporary hoses, hose bibbs, or submerged outlets present

Yes No N/A

Backflow Prevention Assemblies

Required backflow prevention assembly installed where indicated critical (required)

Yes No N/A

Assembly type matches the hazard level and service application critical (required)

Note (optional)

Assembly is accessible for testing, maintenance, and AHJ review critical (required)

Yes No N/A

Assembly shows no visible leaks, damage, corrosion, or tampering critical (required)

Yes No N/A

Assembly is installed with adequate clearance and orientation for inspection

Yes No N/A

Documentation, Compliance, and Corrective Actions

Deficiencies documented with location and description critical (required)

Immediate public health risk present critical (required)

Yes No N/A

Corrective action deadline assigned

Note (optional)

Follow-up testing, repair, or reinspection required critical (required)

Yes No N/A

Inspector signature captured critical (required)

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Run: Cross-Connection Control Survey

Inspection Details

Water Service Entry and Meter Area

Cross-Connection Identification

Backflow Prevention Assemblies

Documentation, Compliance, and Corrective Actions

Get your results